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Our fight against insurance fraud

A small percentage of health care providers, agents, and policyholders/individuals intentionally deceive or misrepresent themselves knowing their deception could result in an unauthorized benefit to themselves or another person. This is called insurance fraud, and it’s not a victimless crime. It may result in higher prices for goods and services or job loss due to financial burdens placed on employers.
  
Each year insurance fraud costs all types of insurance companies and their customers: 

• The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year.
• The Coalition Against Insurance Fraud estimates that insurance fraud costs the United States $308.6 Billion, annually.  Of that amount, the estimates of insurance fraud for health care are $36.3 billion and life are $74.7 billion. 
• Older Americans lose an average of $34,200 when they’re exploited by family, fraudsters, and others.
• The FBI estimates that the total cost of insurance fraud (excluding health insurance) is more than $40 billion per year, and it costs the average U.S. family between $400 and $700 per year in increased premiums.
• One in five Americans think it is acceptable to plot against insurance companies under certain conditions.

Insurance fraud can take many forms:  

• Billing for services not actually performed
• Attempting to collect life insurance benefits while the insured is alive
• Misrepresenting a procedure performed to obtain coverage, such as a cosmetic procedure
• Misrepresenting dates or locations of services
• Allowing someone else to use an insurance card/identity to obtain care
• Forging or altering bills

We are continuing to improve our efforts in our fight against insurance fraud through training, early detection, and prevention.

What we’re doing to fight insurance fraud?

Our company takes the fight against fraud very seriously. Our Special Investigative Unit’s (SIU) primary responsibility is to carefully review and investigate all suspected fraud referrals. If fraud is suspected, SIU will cooperate with state insurance departments, fraud divisions, and local law enforcement for the prosecution of fraud cases. 

What you can do

We believe our policyholders play an important role in the detection of fraud. Here are some ways you can help prevent fraud:

• Review your Explanation of Benefits Statements (EOB) to ensure the accurate dates of service, types of services rendered, and names of providers.
• Compare your medical bills to your EOB for irregularities.
• Always protect your insurance ID card and personal information
• Hang up on robocalls.
• Be cautious about unsolicited emails.
• Report suspected fraud as soon as possible.

What to do if you suspect fraud

If you suspect someone may be committing a fraud against our company, you can:

• Contact the 800 number on the back of your insurance ID card
• Contact our Fraud and Ethics Hotline at 800-678-6685
• Or visit our EthicsPoint Web Reporting System page
• Iowa policyholders may contact the Senior Medicare Patrol (SMP)

And please provide the following information:

• The insured’s name
• Policy number, if available
• State where suspected fraud occurred
• Date of loss
• Nature and details of the suspected fraud
• Your contact information

All calls and website inquiries will be handled discreetly and confidentially.

Thank you for your efforts to combat insurance fraud. 

Last published June 2023